Issues in Religion and Psychotherapy

Volume 31 | Number 1 Article 5

4-1-2007

The Therapeutic Value of Experiencing andExpressing GratitudeVaughn E. Worthen

Richard L. Isakson

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Recommended CitationWorthen, Vaughn E. and Isakson, Richard L. (2007) "The Therapeutic Value of Experiencing and Expressing Gratitude," Issues inReligion and Psychotherapy: Vol. 31 : No. 1 , Article 5.Available at: https://scholarsarchive.byu.edu/irp/vol31/iss1/5

ISSUES IN RELIGION AND PSYCHOTHERAPY 2007

Therapeutic Value of Experiencing

and Expressing Gratitude

VAUGHN E. WORTHEN, PHD, AND RICHARD L ISAKSON, PHD

Brigham YOllng University

VOLUME 31

Gratitude has recently received a significant amount of research attention in the emerging field of positive

psychology. Gratitude interventions are being empirically validated and are showing great promise in enhancing lije

satisfaction, decreasing depression and anxiety, coping with adversity, facilitating relationships, building civic and

moral aspirations and behaviors, and promoting physiological benefits as well. This article will tie the empirical

literature to an LDS theology that has long taught and currently advocates for the cultivation ofgratitude as an

essential component of a spiritually based, meaningful, and happy life. An empirical overview of the benefits

ofgratitude will be provided, potential gratitude interventions will be suggested, and principles for intervention

effectiveness will be discussed.

L ouisa Mellor Clark was the oldest living child of

James and Mary Ann Mellor who crossed the plains

in the Martin handcart company. Louisa was 16 at the

time of the handcart trek. She recorded the following

incident in her journal:

The first snowstorm left about two feet of snow on the

ground, and we began to feel very nervous. We had to

wade through more streams, and sometimes up to our

waists, and when we got through our clothes would

freeze on us until a gteat many gave up and many died,

mostly old people. At last the snow got to be four and

five feet deep and often we had to shovel a road before

we could move. Thus our traveling was very slow and our

provisions nearly gave out.

My mother, still being weak, finally gave up and said she

could go no further. The company could not wait for her,

so she bade my father goodbye and kissed each one of

the children Godspeed. Then my mother sat down on

a boulder and wept. I told my sister, Elizabeth, to take

33

good care of the twins and the rest of the family, and that

I would stay with mother. I went a few yards away and

prayed with faith that God would help us, that He would

protect us from devouring wolves, and asked that He

would let us reach camp. As I was going back to where

my mother was sitting I found a pie in the road. I picked

it up and gave it to mother to eat. After resting awhile we

started on our journey, thanking God for the blessings. A few

miles before we reached camp we met my father coming

out to meet us. We arrived in camp at 10:00 p.m. Many

times after that mother felt like giving up and quitting, but then

would remember how wonderful the Lord had been to spare her

Vaughn E. Worthen, PhD, is a Clinical Pnifessor of Counseling Psychology

at Brigh'1In Young University in Provo, Utah. Riehm'd L. I-"lbon, PhD, is

a Clinical Professor of Counseling Psychology at Brigham Young University

in Provo, Utah. Both work in the Counseling and Career Center on the

BYU campw. Correspondence conceming this article should be addressed to

Vaughn E. Worthen, PhD, Counseling and Career Center, Brigham Ymmg

University, 2529 WSC, Provo, UT. E-mail: vaughn_worthen@byu.edu

VOLUME 31

so many times, and ojJercd a prayer ofgratitude instead. So shewwt on her way rejoicing while walking the blood-stained path

of snow [italics added] (Carter, 1975, p. 305).

Mary Ann Mellor's life-altering manifestations of

gratitude were not simply based on finding a sustaining

"pie:' but on the more complete recognition that God

cared about her and her family, as evidenced by His

intervention. Recognizing the hand of God in life leads

to a deep sense of God's grace. Thus, for religiously ori­

ented individuals, gratitude may also be an expression

of faith in God.

Gratitude can have a profound effect on perspective.

As one author asserts, "It seems obvious that gratitude

is prominently involved, indeed vital, for living a good

life" (Shelton, 2004, p. 265). When individuals feel

discouraged, anxious, or depressed, a grateful outlook

helps to balance perspective and brings to remembrance

that even in challenging times life offers many gifts.

Shifting attention from problems to blessings activates

more effective problem solving efforts. Gratitude is

more likely to promote endurance and thriving in times

of adversity. Gratitude operates in times of abundance,

leading to satisfying and happy lives while helping retain

humility. The purpose of this article is to explain the

therapeutic value of gratitude and to suggest principles

and potential interventions to cultivate it.

Gratitude has been extolled as a virtue in nearly every

culture throughout time. It is a universally desired virtue

at personal, interpersonal, organizational and commu­

nity levels. In a sample of older adults, gratitude was

found to be the third most common discrete positive

affect, experienced by 90% of the sample (Chipperfield,

Perry, & Weiner, 2003). It is a core element of many

religious orientations and is central to Christianity. It

is related to feelings of contentment (Walker & Pitts,

1998), hope (Overwalle, Mervielde, & De Schuyter,

1995), joy (Schimmack & Reisenzein, 1997) and hap­

piness (Overwalle et al., 1995). Gratitude's antitheses

are hate, jealousy, contempt (Schimmack & Reisenzein,

1997) and resentment (Roberts, 2004).

WHAT IS GRATITUOE:'

Gratitude is a positive emotion and has also been

identified as a personal strength or character virtue

(Peterson & Seligman, 2004). It is receiving significant

34

ISSUES IN RELIGION AND PSYCHOTHERAPY 2007

research attention in the emerging field of positive psy­

chology.l In one study (Gallup, 1998), 67% of adults

said that they expressed gratitude to others "all the

time:' In the same study, 54% said that they expressed

gratitude to God "all the time:'

Gratitude is a positive experience and comes from recog­

nizing gifts or blessings and feeling thankful. Gratitude

is also an attitude, a way of perceiving life, where indi­

viduals are attuned to the beneficial actions of others on

their behalf. This attitude might be characterized as sit­

uational or chronic. Those exhibiting chronic gratitude

are said to possess a grateful disposition. Gratitude is also

a habit that can be cultivated. Grateful thinking devel­

ops a disposition or tendency to focus on the blessings

of life. Gratitude is also a coping response to challenging

and difficult circumstances. Thus, on closer inspection,

gratitude has emotional, attitudinal, characterological,

and situational components.

LOS PERSPECTIVE

LDS leaders have recognized and continually taught

the importance of gratitude. Gratitude has been called

a "spiritual attribute" (Hunter, 1997) and a "divine prin­

ciple" (Hinckley, 1997). It has been described as one of

the foundational virtues of "true character" (Benson,

1988). President Thomas S. Monson (2000) spoke of

the power of gratitude when he stated, "We can lift our­

selves, and others as well, when we refuse to remain in

the realm of negative thought and cultivate within our

hearts an attitude of gratitude" (p. 2). President Joseph

F. Smith (1939) explained the benefits of gratitude, stat­

ing that "the spirit of gratitude is always pleasant and

satisfying because it carries with it a sense of helpfulness

to others; it begets love and friendship, and engenders

divine influence. Gratitude is said to be the memory

of the heart" (p. 262). Adding to this, Elder Robert D.Hales (1992) suggested, "In some quiet way, the expres­

sion and feelings of gratitude have a wonderful cleansing

or healing nature....Gratitude brings a peace that helps

us overcome the pain of adversity and failure" (p. 63).

Gratitude is identified as one of 17 values advocated

in For the Strength of Youth (The Church of Jesus Christ

of Latter-day Saints, 2001). President Hinckley (1997)

has counseled us to "cultivate a spirit of thanksgiving

for the blessings of life and for the marvelous gifts

and privileges you enjoy" (p. 246). Finally, George Q.

THERAPEUTIC GRATITUDE

Cannon (1867/1974) articulated one of the key reasons

why gratitude is such a powerful force for good when he

stated, "When our hearts are filled with thanksgiving,

gratitude, and praise to God, we are in a fit condition

to receive additional blessings, and to have more of the

ourpouring of His Holy Spirit" (p. 330). When indi­

viduals experience and express gratitude, they open the

doors to divine influence and the companionship of the

Holy Spirit, for their own benefit and for the well-being

of others.

PSYCHOLOGICAL AND PHILOSOPHICALPERSPECTIVE

Psychological and philosophical definitions of grati­

tude include the following: "the willingness to recognize

the unearned increments of value in one's experience"

(Bertocci & Millard, 1963, p. 389) and "an estimate

of gain coupled with the judgment that someone else

is responsible for that gain" (Solomon, 1977, p. 316).

Robert Emmons and Michael McCullough (2003,

2004) suggest four elements in their definition: (1) the

capacity to perceive that an intentional gift or blessing

has been received, or at least that someone (mortal or

divine) attempted to give a gift, even if not received or

experienced by the intended recipient, (2) no expecta­

tion that the gift/blessing is earned or deserved, (3)

recognition of the effort of the giver, sometimes at high

cost to themselves, and (4) no expectation of reciproc­

ity. Gratitude can be distinguished from "indebtedness;'

which generally feels less positive or even negative, car­

ries with it a sense of obligation, and is embedded in

reciprocity. Gratitude is absent feelings of manipulation,

but indebtedness could feel demanding and may even be

experienced as manipulative.

In making a case for gratitude as a positive response

to life, the premise of this article is based on the belief

that individuals have the capacity to choose their atti­

tudes toward people and situations. Experiencing and

expressing gratitude or any positive response to life's cir­

cumstances is dependent on the ability to choose one's

attitude. George Kelly (1955), the creator of Personal

Construct Theory, based his theory in the tenets of "con­

structive alternativism;' stating, "There are always some

alternative constructions available to choose among in

dealing with the world. No one needs to paint himself

into a corner; no one needs to be completely hemmed

35

\VORTHEN & ISAKSON

in by circumstances; no one needs to be the victim of

his biography" (p. 15). Viktor Frankl (1963) articu­

lated this same idea when he stated, "Everything can

be taken from a man bur one thing: the last of human

freedoms-to choose one's attitude in any given set of

circumstances, to choose one's own way" (p. 104). Frankl

(1973) also indicated that with this freedom "men can

give meaning to their lives by ... experiencing the Good,

the True, and the Beautiful" (p. xiii). Gratitude is one of

those "Goods;' and as a response to life, it is only possible

if it is an option clients can choose. We argue that it is,

and that it can be cultivated. The following benefits are

available to those who adopt a grateful approach to life.

THE EFFECTS OF GRATITUDE

Feeling and expressing gratitude provide a variety of

benefits. Recently, several studies have been devised

to test whether interventions to promote gratitude can

increase positive affect, reduce negative affect, and lead

to other helpful positive outcomes. These studies have

demonstrated promising results (Bartlett & DeSteno,

2006; Emmons & McCullough, 2003; Lyubomirsky,

Tkach, & Sheldon, 2004; McCraty & Childre, 2004;

Seligman, Rashid, & Parks, 2006; Seligman, Steen,

Park, & Peterson, 2005; Sheldon & Lyubomirsky, 2006).

The effects of gratitude are highlighted in six domains

of life: enhancing happiness and life satisfaction; mental

health benefits; coping with adversity; interpersonal

benefits; moral, civic, and spiritual benefits; and physical

benefits (see Table 1).

Although gratitude has many beneficial outcomes,

some of these may be time-limited and situation bound,

without necessarily leading to lasting changes or perma­

nent increases in levels of life satisfaction. Temporary

effects are more likely to occur when individuals only

periodically experience gratitude. Other factors can

negate the effects of gratitude: diminished capacity for

empathy, self-absorption, becoming overwhelmed by

circumstances, getting stuck in chronic misery, resent­

ment, sense of entitlement, becoming too materialistic,

taking too much credit for successes or failures, living

life without being fully engaged, living pressure-filled

and fast-paced lives, comparisons with others, and any­

thing that reduces appreciation and recognition of the

benefits and blessings that come unearned and from the

goodwill of others.

VOLUME 31

Table 1Positive Effects ofExperiencing and Expressing Gratitude

ISSUES IN RELIGION AND PSYCHOTHERAPY 2007

Domain

Enhanced Life Satisfaction

Mcneal Health Benefits

Coping with Adversiey

Finding

Expressing gratitude helped 90% of adults!

teens feel "somewhat/extremely" happy.

Writing and thinking about experiences ofgratitude helps people fcelluppier and moreoptimistic.

Grateful disposition correlated with positiveemotionality, vitality, happiness, life sarisfaccioI1,hope, and optimism.

Counting blessings led to increased lifesatisfaction, wel1~being,positive afTect, optimism

and reductions in negative affect as well asmaking more progress on personal goals.

Gratitude was one of 5 our of 24 characterstrengths that was strongly and consistentlyassociated with life satisfaction.

Gratitude increases access to positive memories.

Gratitude may forestall the etTects ofadapution 2 to positive events (sustaininghappiness longer).

Grateful disposition correlated negatively withdepression and anxiety.

Gratitude interventions led to decreases indepression and negative affecr.

Thankfulness was associated with teducedrisks for m~or depression, phobias, generalizcdanxiety disorder, panic disorder, and bulimianervosa, nicotine dependence, alcoholdependence, drug abuse or dependencc, andadult antisocial behavior.

Trait gratitude negatively correlated withresentment about the past.

Gratitude was the second most frequently feltemotion after 2001 terrorist attack.

Source

Gallup. 1998

Emmons & Crumpler, 2000;

Watkins. Woodward. Stone, & Kolts. 2003

Adler & Fagley, 2005; McCullough, Emmons.

& Tsang. 2002

Emmons & McCullough, 2003; Lyubomirsky.Tkach, & Sheldon, 2004

Park, Peterson. & Seligman, 2004

Watkins, Van Gelder. & Maleki, 2006

Sheldon & Lyubomirsky. 2004

McCullough et al., 2002; Woodward, MOLIa. &

Watkins, 1998

Seligman ee al., 2005; Seligman et al., 2006;Sheldon & Lyubomirsky, 2006

Kendler et al.. 2003

Watkins, Woodward. Stone, & Kolts, 2003

Frederickson, Tugade. Waugh, & Larkin. 2003

Hurricane Andrew survivors often experienced CofTman, 1996gratitude in the face of loss.

Trauma survivors with PTSD who experienced ivlassingale et al., 2001more gratitude had significandy lower levels of

PTSD symptoms.

Viemam vets diagnosed with PTSD who had Kashdan, Uswatte, & Julian, 2006

greater dispositional gratitude cxpCl'iencedgreater daily well being.

A grateful approach to negative life events helps 'Watkins, Grimm. & Hailu, 1999reframe memories of unpleasant evcnts.

THERAPEUTIC GRATITUDE

Interpersonal Benehts Gratitude intervention led to an incrcased sense

of interpersonal connectedness.

WORTHEN & ISAKSON

Emmons & McCullough, 2003; McCulloughet aI" 2002

Moral, Civic, and Spiritual Benefits

Those who tend to experience gratitude more McCullough et at., 2002frequently reported being more forgiving.

Those rated as having a more grateful McCullough et aI., 2002disposition were viewed as more empathic and

supportive of others.

Grateful people reported being less envious McCullough et at., 2002of others and more generous with rheir

possessions.

Those in the gratitude interventions reported Emmons & McCullough, 2003

helping someone marc frequently.

Religiously inclined people experience graritude McCullough, Tsang, & Emmons, 2004more frcL1uently than others.

Those thanked I,)r helping are mnch more likcly Clark, 1975; Goldman, Seever, & Seever, 1982;to help another in the ncar future, Moss & Page, 1972

Grare!'ll people reported being less materialistic McCullough et at., 2002and less oriented to pursuing wealth and more

generous \vith their possessions.

Gratitude and"materialistic striving" have an Polak & McCullough, 2006inverse correlation.

Case managers visited their adolescent cliems Clark, Northrop, & Barkshire, 1988

morc frequently \vhen a"thank you" note was

sent to them by their managers after visits,

Tips were larger when a"Thank You" was placed Rind & Bordia, 1995

on the bottom of the bill.

Thanking people for their business led to an Carey, Clicgue, Leighton, & Milton, 1976increase in sales,

C;ratitude increases efforts to assist benefactors Bartlen & DeSteno, 2006

even when such efforts arc costly, and this eHect

is unique from the outcome produced by an

increase in general positive affect.

Physical Benefits Gratitude interventions led to better sleep

duration and quality, fewer physical complaints,

and more time spent in physical exercise,

Gratitude may help with cardiovascular and

immune functioning,

Gratitude to God reduced the negative effects

of stress on health lor older adults (especiallyfor women),

37

Emmons & McCullough, 2003; Emmons &

Crumpler, 2000

McCraty & Childre, 2004

Krause, 2006

VOLUME 31

All clients can benefit from even simple and infrequent

attempts at fostering gratitude, but the goal of develop­

ing a more grateful disposition takes much effort and

persistence. Everyone, whether religiously oriented or

not, can benefit from enhancing their gratitude and can

find much for which to be grateful. For religiously ori­

ented clients, a grateful perspective on life is most likely

to be present when it is connected to an active awareness

of God's gracious benevolence in their lives. For those

with such a perspective, no experience loses its potential

to teach and bless when they acknowledge God as act­

ing in their best interest. This becomes a catalyst for

increased well-being, leads to seeing the gifts in life more

clearly, and kindles a desire to share their good fortune

with others. Ultimately, from an LDS perspective, the

most important functions of gratitude include soften­

ing and lifting hearts, and opening a channel that allows

God to work in and through them more effectively.

INTERVENTION PRINCIPLES ANDPROCEDURES

Experiencing and expressing gratitude has significant

beneficial effects in a variety of domains. Given that

there are specific positive benefits from experiencing

gratitude, the following questions are relevant: How

can therapists intervene to promote gratitude? What

principles can maximize the utility of gratitude inter­

ventions?

GRATITUDE INTERVENTION STRATEGIES

Since writing may be an important element of the

following interventions, some research indicates that

a different approach should be used in writing about

positive versus negative experiences. For example,

Lyubomirsky, Sousa, and Dickerhoof (2006) found that

"private thought about a positive life event was associ­

ated with higher satisfaction with life than writing or

talking about that event" (p. 701). When writing about

negative events, the analytical nature of writing was

helpful in making sense out of experiences, while just

thinking or ruminating about problems did not help.

Just the opposite was found with positive events. The

act of analytical writing about positive events dimin­

ished the pleasure of these events. In contrast, focusing

on reliving, replaying, and rehearsing positive experi­

ences sustains and maximizes pleasure related to posi­

tive events. Therefore, if clients are asked to write about

ISSUES IN RELIGION AND PSYCHOTHERAPY 2007

their gratitude experiences, consider having them write

in a way that mininiizes analysis and maximizes reliving

and savoring. Encourage descriptive rather than analyti­

cal writing by inviting them to "bask" in the experience

again and include as much detail as possible, such as

their thoughts and emotions at the time.

Counting Blessings. This generally involves listing

3-5 blessings (Emmons & McCullough, 2003). It has

been implemented daily, a few times a week, or weekly.

Certain domains of focus can be suggested for clients

to consider (e.g., health, relationships, noted improve­

ments, lessons learned, etc.).

Making a "Gratitude Visit." This was described in

the Seligman et al. (2005) study. It had a significant

positive short-term impact, which diminished over time.

Ask clients to think about someone toward whom they

feel a special sense of gratitude, write that person a grati­

tude letter, and then make a personal visit to express

thanks and deliver the letter. Here is an adaptation of

Martin Seligman's (personal communication, August

23,2006) elements for this intervention:

+Think of the people-parents, friends, teachers,

coaches, teammates, employers, and so on-who

have been especially kind to you but whom you

have never properly thanked.

+ Choose someone you could meet for a face-to-face

meeting in the next week.

+ Write a specific and concrete gratitude letter that

details how this individual affected your life for

good, and deliver it in person.

+Call the person in advance to schedule a time to get

together.

+ Share the contents of the letter with the person,

including how you are doing now.

+After this visit, take a moment to think about each

of the following questions:

+How did you feel as you wrote your letter?

+How did the other person react to your expres­

sion of gratitude?

+How were you aHected by their reaction?

+Would you like to express your gratitude to

someone else in a similar manner?

+To whom?

Creating a Gratitude Catalogue. Encourage clients

to spend a week developing a comprehensive list of all

their blessings. After they have listed the obvious, see

if they notice a shift to "smaller" blessings (e.g., running

THERAPEUTIC GRATITUDE

water, electricity, etc.). Help them consider as blessings

things that were not previously experienced as such

(e.g., the ability to experience pain of all kinds because

it is a signal that something needs attention, a demand­

ing assignment because it helped them learn something

about their capabilities, the person who cut in front of

them because that experience gave them the opportu­

nity to choose a higher road, etc.).

Appreciating Progress. Help clients recognize and

appreciate their progress. Those with perfectionistic

tendencies may especially benefit from this intervention.

Mood can influence thought and memory, so depressed

individuals may find it difficult to see progress. Here are

some examples: "Are you closer to reaching your goals?"

"Has your health improved?" "Have your relationships

improved?" Sometimes it is helpful to begin with mini­

mal signs, such as, "I'm no longer actively suicidal." Help

them generate grateful feelings, even if they start small.

Appreciating "Small" Things. Most blessings are

of the "small" variety. Barbara Frederickson (2003) sug­

gests that "you can infuse ordinary events with meaning

by expressing appreciation, love and gratitude, even

for simple things" (p. 335). Small blessings are always

available. Waiting for "big" events to occur before expe­

riencing gratitude is counterproductive since they hap­

pen infrequently and often produce less "punch" than

expected, and since, through adaptation, the effects

wear off sooner than anticipated. Learning to regularly

appreciate small things leads to greater awareness and

mindfulness. When the authors were in elementary

school we were taught to "stop, look, and listen" before

crossing the street. In the service of appreciating small

things, invite your clients to "stop, look, and listen" for

a grateful feeling, moment, or experience that has hap­

pened during the day. Assign clients to think or write on

the following ideas:

+ Consider three things that they usually take for

granted that made them feel peaceful, happy, con­

tent, satisfied, or fulfilled today (e.g., I had a good

night's sleep, I enjoyed the fall colors on the trees, I

had the chance to read a good book, my friend called

and we did something together, etc.).

+ Consider three things that didn't occur today that

would have been distressing, unpleasant, or discour­

aging (e.g., I didn't get sick, I didn't fail the exam, I

didn't get yelled at, etc.).

Taking Things For Granted. Encourage clients to

39

\VORTHEN & ISAKSON

make a list of the things they take for granted. Too

often blessings are in plain view but have become invis­

ible. When clients actively renew their attention and

remind themselves of these blessings, they experience an

increase in gratitude.

Eliminating Ungrateful Thoughts. Elder Jeffrey R.

Holland's (2007) counsel is applicable: "No misfortune

is so bad that whining about it won't make it worse"

(p. 18). Have clients identify and list their complaining

and ungrateful thoughts and replace them with grate­

ful thoughts and problem solving strategies. Clients are

prone to gratitude and less likely to complain when they

remember how others have contributed to their well­

being, when they search for lessons in challenging times,

and when they focus on positive action rather than pas­

sive complaining.

Expressing a Gratitude Prayer. Suggest to spiritually

oriented clients that they regularly take time to dedicate

an entire prayer for expressions of gratitude. Encourage

them to be specific and to go beyond the obvious. Going

beyond the obvious may involve little twists; for exam­

ple, being grateful for the ability to experience emotional

pain because it means they still care; or, in the face of

chronic problems, being grateful for the fact that this

week was no worse than last week; or being grateful that

God gave them the ability to endure another day. When

they recognize the extent of God's niercy in their lives,

they may also increase their love for Him.

Using Gratitude Language. Train clients to use the

language of gratitude. This can occur by frequently

writing notes of appreciation. Help them find ways to

say "thank you" in a meaningful way, both to those they

are close to as well as others they encounter, such as the

bagger, the cashier, or the postal worker. Have them

focus on consciously and frequently thinking, saying,

and writing grateful things.

Using Downward Social Comparisons. If clients are

experiencing difficulty in feeling gratitude, have them

think of situations they are glad they don't experience,

such as famine, war, or debilitating illness. Invite them

to think of someone they would not want to trade

places with who seems to have things harder than they

do. Have them say and think things such as, "At least

I don't have to deal with chronic pain:' Help them

recognize that although their situation is not ideal, it

could be worse. Encourage them to be grateful that it is

not worse, while continuing to hope and work towards

VOLUME 31

improvement.

Discovering Unexpected Gratitude. Challenging

times may provide the most important opportunities for

grateful thinking. Some have called this "benefit finding"

(Affleck & Tennen, 1996). Finding ways to experience

some element of gratitude in difficult circumstances

helps clients endure and even thrive, as referred to in the

opening story of this article.

Invite clients to think about a current situation that is

troubling them. What can they find in that experience

for which to be grateful? They might find opportunities

to learn something new, to practice something hard, to

develop courage, to learn to trust in God, to find out

more about themselves, to appreciate the support that

is available to them, and to recognize that the situation

is making them more patient, empathic, or less judg­

mental.

Life's difficult experiences temper and refine, and

although this is sometimes quite painful, often the most

significant points of growth come through these experi­

ences. They can provide the focus for future efforts to

change things that are experienced as unjust or unfair

or to prevent bad things from happening to others.

Much of the good in this world has come about from

suffering that is transformed into a social contribution.

Often, the attempt to find benefits in challenges actually

changes the nature of the problem itself, leading to new

solutions.

Promoting Marital Gratitude. Expressions of grati­

tude enhance any relationship. When marital conflict or

tension is high, or couples are discouraged or suffering

painful hurts, it is helpful to encourage partners to take

time out to focus on things they appreciate about each

other. This must be done carefully and appropriately

and not as an avoidance maneuver that circumvents real

problems. The couple should not use this as a tool of

manipulation. When undertaken seriously and sincerely,

it brings increased awareness to the positive traits and

behaviors in ones spouse, softens hearts, and promotes

healthier environments for mutual problem solving.

Sometimes the expressions of gratitude are the solution.

For a list of further gratitude resources, see the

Appendix.

GRATITUDE INTERVENTION PRINCIPLES

The following principles can help maximize the

utility of gratitude interventions.

Effort and Continuity. Long-term benefits from

40

ISSUES IN RELIGION AND PSYCHOTHERAPY 2007

gratitude interventions are more likely when there is

continued commitment to implementation. One-time

interventions such as the "Gratitude Visit" (Seligman et

aI., 2005) had an immediate significant positive impact,

but at a 3-month follow-up, adaptation had returned

individuals to their baseline emotional state. Sustained

commitment is necessary. As Seligman et al. (2005)

found, "The degree to which participants actively con­

tinued their assigned exercise on their own and beyond

the prescribed one-week period mediated the long-term

benefits" (p. 416).

Self-Concordance. Individuals show greater commit­

ment to performing gratitude exercises when interven­

tions are more congruent with their values and needs

(i.e., self-concordance; Sheldon, 2002). Motivation is

easier to sustain when activities have intrinsic value.

Self-concordance is enhanced when interventions are

tailored and a rationale is given related to the individ­

ual's basic needs and values. Implementation improves

with specific and concrete plans that clients help create.

Therapy drop out rates varied significantly in a ran­

domly controlled trial study of the treatment of depres­

sion conducted by Seligman, Rashid, & Parks (2006),

with a 13% drop out rate for Positive Psychotherapy,

a 40% drop out rate for treatment as usual, and a 29%

drop out rate for treatment as usual with antidepressant

medications. The significantly lower drop out rate of the

Positive Psychotherapy participants may indicate that

clients find positive and additive interventions easier

and more compelling to carry out.

Variation. Varying interventions help to keep activities

fresh, staving off the effects of adaptation. Interventions

may lose some of their efficacy if they become too

habitual, but developing a grateful attitude does take

sustained and regular practice. To minimize the effects

of adaptation, vary the way gratitude exercises are enact­

ed; for example, change the domain of focus (e.g., health

could be the focus on one occasion, sources of social

support on another occasion, and looking for the "silver

lining" in adversity on yet another occasion). Varying

the frequency or intensity of interventions (e.g., once a

week or three times a week rather than every day) may

maximize effectiveness. Implementing different types

of gratitude interventions, as well as interspersing non­

gratitude interventions, may also be useful.

Variation may conflict somewhat with the prin­

ciple of effort and continuity. Whereas Emmons and

THERAPEUTIC GRATITUDE

McCullough (2003) found that daily listings were gen­

erally more "powerful" than weekly listings of gratitude,

Lyubomirsky, Sheldon, and Schkade (2005) found that

well-being increased only in those participants who

counted their blessings once a week rather than three

times a week.

Social and Self Comparisons. Gratitude often aris­

es out of social comparisons. For example, increased

gratitude may be experienced by our clients when they

encounter someone whose health is worse than their

own, or someone who has difficulty even obtaining the

basics of life. Downward social comparison processes

are at work when individuals see themselves as better off

than another. This is an effective method for facilitating

gratitude if it does not turn to judgment about the other

person or pride about abilities and/or circumstances

(i.e.,'] did it, why can't they").

Comparisons with self may have fewer negative con­

sequences. If clients can see how things are improving

(comparisons with their past), or how they are getting

closer to what they want (comparisons with their ide­

als), they are prone to experience gratitude. Those with

very high self-comparison standards, such as perfection­

ists, may find this difficult. Self-comparisons may not

work when a person's situation is deteriorating, such as

through poor health or aging. Other gratitude interven­

tions can be helpful in these situations as they reflect on

other aspects of their lives (e.g., a life well lived, the small

things of life, the kindness of others, etc.).

Social Support. Social support is helpful in imple­

menting many kinds of activities. Whenever the assis­

tance of another can be used to help clients practice

gratitude, it is more likely that gratitude will occur.

Encourage clients to observe, seek our, and associate

with someone they think is particularly grateful. This

individual may be thought of as a gratitude coach.

Becoming more aware of the power of social support

may also become a source of gratitude.

Attentional Focus. Much of the value of gratitude is

due to clients shifting their attention from hassles and

problems towards things that are going well and bless­

ings. The experience of increased positive emotions

leads to improved problem solving. Gratitude counters

the tendency to ruminate about problems and avoid

problem solVing efforts. Rumination has been found to

be a major factor in depression, anxiety, and inability to

overcome interpersonal hurts (Bono & McCullough,

4 1

\J,/ORTHEN & ISAKSON

2006). A shift towards a grateful perspective serves

as a form of "distraction" and refocuses attention on

potential positives rather than on feared or experienced

negatives, providing a balanced and broader perspective

on current challenges. Current research indicates that it

only takes 8 minutes of distraction to help a person feel

better (Lyubomirsky & Tkach, 2003). A grateful orien­

tation shifts attention towards things that are going well,

successes, "silver linings," and "small gifts" such as smell,

sight, touch, and so forth.

Cultivating Empathy. Empathy is an essential factor

in experiencing gratitude. Those who cannot empathize

with others will find it difficult to see the efforts and

sacrifices made on their behalf. Without empathy, they

may view the actions of others as being merely self-serv­

ing. Just as gratitude requires empathy, it also cultivates

empathy. Being able to see blessings is part and parcel

of recognizing the benevolent actions of others. Indeed,

clients may recognize that at times they don't even merit

the gifts bestowed upon them. In cultivating empathy,

they may recognize a mutual dependence on others

and may have a desire (versus a feeling of obligation) to

return kindness.

Acceptance. There are two forms of acceptance,

active and passive. Active acceptance is the ability to

accept, embrace, and even welcome the gifts of life

in whatever form they arrive, believing that they can

teach and refine. This is not a masochistic, "suffering

proves how much God loves me" perspective. It is not

seeking out suffering. Active acceptance is fostered by

believing in a benevolent God who has the well-being

of His children in mind. Those who believe that God

is a "potter" and that He is shaping His "clay" (Isaiah

64:8) recognize that some of His stretching, pinching,

and kneading may be painful prior to the finished vessel

being revealed. Active acceptance is recognizing that the

design of life allows for and even calls for a portion of

adversity along with life's privileges. Active acceptance

acknowledges that the positive experiences of life are

inextricably intertwined with the ability to experience

pain and disappointment. Paul's declaration is one dem­

onstration of this attitude: "Most gladly therefore will I

rather glory in my infirmities, that the power of Christ

may rest upon me" (2 Corinthians 12:9). Paul's attitude

reflects active acceptance, since he sees something posi­

tive coming from his infirmities.

Those who accept, tolerate, or acknowledge things as

VOLUME 31

they are rather than as they wish things were, especially

regarding things that cannot be changed, are demon­

strating passive acceptance. Passive acceptance is more

abour enduring than learning. It may even be somewhat

fatalistic (i.e., just "grit it out" until it is over). Both atti­

tudes can prove usefuL

The ability to accept things as they are and to find

benefit even when wishing they were different is a com­

ponent of gratitude. Obsessing over things that cannot

be controlled limits our ability to feel gratefuL Those

who adopt an active acceptance come to see that almost

every experience may have laden within it some gift,

some benefit, something that will make them better one

way or another. As President Brigham Young taught, as

cited in the Discourses of Brigham Young (Widstoe, 1954),

"Every trial and experience you have passed through is

necessary for your salvation" (p. 345). Acknowledging

that some circumstances or conditions cannot be con­

trolled may actually prove helpful in fostering gratitude

(e.g., although my son is struggling and I can't control

his decisions, I am grateful that God's grace is available

to him and me). Gratitude leads to increased feelings of

contentment, peace, joy, hope, and happiness even when

circumstances are uncontrollable. When appropriate,

encourage clients to accept their situation with all its

"thorns:'When fitting, constructively explore the possible

lessons to be found even in challenging circumstances.

CONCLUSION

Individually designing interventions using the prin­

ciples listed above will assist therapists in their efforts

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FOOTNOTES

IPositive psychology was named and formally launched

by Martin Seligman during his tenure as President of

the American Psychological Association in 1999. His

initiative brought together a collection of researchers

and practitioners under a common umbrella. It has been

defined as "the study of the conditions and processes that

contribute to the flourishing or optimal functioning of

people, groups, and institutions" (Gable & Haidt, 2005,p. 104), the "scientific study of ordinary human strengths

and virtues" (Sheldon & King, 2001, p. 216), and the

scientific study of"what makes life worth living" (Linley,

Joseph, Harrington, & Wood, 2006, p. 5). The current

focus on human strengths is receiving scientific investiga­

tion designed to help us better understand the role, influ­

ence, and effects of personal and community strengths

and virtues.

2The emotional baseline of most individuals appears

to be slightly positive (Reis & Gable, 2003) if no strong

positive or negative events are occurring. The adaptation

effect or habituation suggests that the impact of positive

or negative events (Brickman & Campbell, 1971) natu­

rally diminishes over time, bringing people back to their

emotional baseline, so that individuals are often no hap­

pier or unhappier than before the positive/negative event.

This adaptation often occurs more quickly than most

assume. Some have concluded that "bad is stronger than

good" (Baumeister, Bratslavasky, Finkenauer, & Vohs,

2001) because "negative events appear to elicit more phys­

iological, affective, cognitive, and behavioral activity and

prompt more cognitive analysis than neutral or positive

events" (Taylor, 1991, p. 67). Therefore, significant nega­

tive events such as acquiring a permanent disability may

alter levels of happiness more than significant positive

events. In general, though, adaptation is active in the ordi­

nary and common events in life and may help to explain

why even though a favorite team wins a championship,

the effects of their victory wear off fairly quickly, and even

though individuals may be involved in a fender bender,

they return fairly quickly to their normal levels of hap-

45

WORTHEN & ISAKSON

piness. There are many explanations for this mechanism.

One reason for this effect may be the "signaling" function

of emotions. If individuals remained enlOtionally aroused,

either too high or too low, their physiological alert sys­

tems would not work appropriately to signal them about

new events in their life, such as a threat or an opportunity.

Adaptation seems to be more active in some domains of

life than in others. Whereas acquiring a new possession

may give only a quick temporary boost to happiness and

be very reactive to the forces of adaptation, developing a

new friendship would likely have a stronger, more lasting

impact on happiness and be less influenced by adaptation.

This adaptation effect seems to indicate that some things

contribute more effectively to lasting happiness. All of this

leads to the question of just how malleable happiness is,

and whether therapists can and should work to increase

an individual's level of happiness over a sustained period

of time, or whether there is a natural "set point:' Are posi­

tive or negative changes in happiness doomed (in the case

of positive affect) or destined (in the case of negative

affect) to return to this "set point"?

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